Comparison Between the Combined Analysis and the DeMeester Score to Predict Response to PPI Therapy

Abstract

Background

Distal esophageal acid exposure can be quantified using the DeMeester score (DS) or percentage time pH<4. In addition to these parameters, symptom index (SI) is used to evaluate the association of symptoms and acid reflux. Combined analysis (CA) including the SI and percentage time pH<4 provides a more comprehensive interpretation of pH monitoring results.

Aim

To assess whether using CA compared with DS is more accurate for interpretation of pH monitoring.

Method

pH studies from 450 patients (303 female; mean age 53; range 11 to 88) off therapy between July 2002 and October 2004 were analyzed. DS (normal<14.7), percentage time pH<4 (normal; upright<6.3%, recumbent<1.2%), and the SI (positive symptom if ≥50%) were calculated for each patient. Symptom responses to proton pump inhibitors (PPIs) were assessed in patients with discordant DS and CA.

Results

Sixty-six patients were identified as having a normal DS and an abnormal CA. Forty-one (62%) patients had abnormal reflux according to the CA and 25 (38%) had normal reflux but a positive SI. Ten patients were lost to follow-up, 43 (84%) improved on and were currently taking a PPI and 8 (16%) found no benefit from taking a PPI. Five (9%) patients were never tried on a PPI and 3 were still symptomatic. Twenty-two (88%) patients with a positive SI and normal reflux were followed-up (3 never prescribed PPI) and 17 (90%) improved with a PPI.

Conclusions

Interpreting the results of pH monitoring based solely on the composition DS misses patients with an acid “sensitive esophagus,” a group of patients who benefit from PPI therapy.